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Monday, Nov. 30, 2009

On World AIDS Day, where the battle stands now

Good news about HIV/AIDS came last week when the World Health Organization said more powerful drugs and better prevention programs have cut new HIV infections worldwide by 17 percent in the past eight years. And rates in Florida dropped by 6 percent between 1998 and 2007, according to the state health department.

Still, since HIV/AIDS was first reported in 1981 in the United States, 1.7 million people have been infected and 580,000 have died.

Cases soared in the 1980s, plummeted in the 1990s as antiviral drugs were introduced, but have plateaued since about 2000 with more than 50,000 new HIV cases a year, according to the U.S. Centers for Disease Control and Prevention. And even though HIV rates are slightly down in Florida, they are higher than U.S. rates. Florida has 6 percent of the U.S. population and 11 percent of its AIDS cases and deaths. Miami and Fort Lauderdale consistently rank in the top five big U.S. metropolitan areas for HIV/AIDS.

With World AIDS day proclaimed for Tuesday, we asked Dr. Margaret Fischl, pioneering researcher at the University of Miami School of Medicine, about the fight against HIV/AIDS.

Q: AIDS deaths in the United States have plateaued since about 2000. Do you think this will change?

A: HIV is a stable epidemic with a constant rate of new infections each year. The people who are disproportionately affected are men who have sex with men and African American men and women. You still see new cases, and not everyone who is infected is seeking care. I think it will continue until we get more people tested and into care.

Q: How would you describe HIV today? How serious is it?

A: I look at HIV now as a chronic infection. If treated, people can live a relatively normal, healthy life. But we can't knock the virus out of the body yet. We have to treat it for the duration of life. It puts a burden on both patient and health care system.

Q: Powerful new antiretroviral drugs have increased the number of people living long lives in apparently good health with well-controlled HIV. But new studies now say these survivors may be more susceptible to other diseases?

A: This is being recognized now -- with dementia, liver disease, kidney and heart disease and cancers. It's looking like it's related to the HIV virus, and also to the anti-retroviral therapy used against it. Data gathering is going on now to get a better handle on this.

Q: What should local health officials be doing to fight HIV?

A: ``Test and treat'' programs are very valuable. You go into high-incident areas by ZIP code in Miami or Washington or Atlanta, and knock on everyone's door to get them tested and into treatment. The National Institutes of Health is looking into this. We need to do it in South Florida.

Q: What about a vaccine against HIV? Human trials in Thailand sound hopeful, and you're making progress with a vaccine to be given to people who already have HIV. How soon might there be an effective vaccine to fight HIV?

A: I'll go out on a limb and say within the next five years. I think there will be one that will prevent HIV. Nothing is 100 percent. But if you can prevent it in 60 or 70 percent of people it would be remarkable. Then you want to push for at least 90 percent. Really productive research is moving forward. You will see totally new approaches that are quite different in terms of how you construct a vaccine, to force the immune system to respond better.

Q: Will we ever be able to ``defeat'' HIV/AIDS as we have defeated, say, polio?

A: We need to understand how the virus is coded into the genes, and how we can knock it out. We need treatments to push the immune system to better respond. There could be totally different vaccines and drugs that go beyond antiretrovirals, so eventually we can stop therapy. We will have this in less than five years.